Individual
MR. TRAVIS JAMES BUCHANAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4304 W HOUSTON ST, BROKEN ARROW, OK 74012-4519
(872) 231-3162
(702) 977-1496
Mailing address
PO BOX 74008272, CHICAGO, IL 60674-8272
(702) 899-0595
(702) 977-1496
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1939
OK
363AS0400X
Surgical Physician Assistant
1939
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1939
OKLAHOMA STATE BOARD OF MEDICAL LICENSURE AND SUPERVISION
OK
05
—
200319100A
—
OK
Enumeration date
01/04/2011
Last updated
10/06/2025
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